Substance Abuse and Public Policy (94-2e)

Government actions related to substance abuse in Canada have grown since the first small piece of federal legislation in 1908 prohibiting non-medical opiate use. Efforts to prevent, treat and control substance abuse now also focus on tobacco, alcohol, solvents, and prescription and over-the-counter medications.

This review examines federal substance abuse policy with respect to both legal and illegal drugs in Canada. It provides a general profile of various substances that are abused or misused. Where possible, it assesses the health, social and economic costs and consequences of substance abuse. While acknowledging the difficulties of determining the nature of drug dependency, the paper describes initiatives aimed at reducing potential harm and at controlling related problems through interventions involving education and prevention, treatment and rehabilitation, enforcement and controls.

BACKGROUND AND ANALYSIS

A. Federal Policy on Drugs

The initial 1987 National Drug Strategy emerged from concern about the abuse of illegal drugs in Canada; however, during its five-year existence, the high social and economic costs attributable to misuse of legal substances also came to be recognized. When a national consultation process explored the impact of Canada’s Drug Strategy (CDS) and the Strategy Against Driving While Impaired (SADWI) in 1991, the participants almost unanimously identified alcohol abuse as the biggest problem. Tobacco use was also seen as needing greater attention. A second concern was the abuse of pharmaceuticals, both prescription and over-the-counter. Street drugs including cannabis, heroin and cocaine were also a significant problem across the country, with solvents and inhalants of particular concern in northern areas.

In 1992, Canada’s Drug Strategy was renewed and combined with the Driving While Impaired (DWI) Strategy. The continued objective was to reduce the harmful effects of substance abuse on individuals, families and communities by addressing both supply and demand. Coordinated by the Department of National Health and Welfare, the Strategy involved several other departments seeking to enhance existing programs and to fund new ones. Of the $210 million allocated to the initiative, 70% was directed to reducing the demand for drugs through prevention, treatment and rehabilitation and 30% to enforcement and control. Other policy actions, such as the development of mandatory testing programs for substance abuse in the Department of National Defence and federally regulated transportation sectors, drew attention to the implications of drug use in the workplace while the Tobacco Demand Reduction Strategy, a three-year initiative announced in 1994, focused on the wider implications of use of a legal substance.

In 1998, the federal government reaffirmed its commitment to the principles of Canada’s Drug Strategy. It also allocated additional funds to a Tobacco Control Initiative. Health Canada is currently working to develop and implement programs, based on the determinants of health model, to promote health and encourage the avoidance of health risks, including those associated with tobacco, alcohol and other drug use. Priority is to be given to the special needs of certain population groups.

Federal policy on various substances is subject to constant pressures for change as new ideas emerge and are carried forward to government by various interests. For example, in 2000, groups concerned about tobacco and alcohol use emphasized the need to denormalize their societal acceptance as legal substances while other groups pushed for wider support of the use of marijuana and heroin for medical and other purposes.

B. Substance Abuse: What Is It?

Substance abuse can be defined as any use of a substance, non-medical or medical, that causes physical or social harm. Substances can be legal, like alcohol and tobacco, or illegal, like cannabis and cocaine. Prescription and over-the-counter drugs can also be misused. The division between legal and illegal shifts when legally available pharmaceuticals are diverted to illegal markets.

The most abused of all drugs are “psychotropic drugs,” those that change the way a person thinks, feels or acts. Many such drugs are prescribed in Canada each year to relieve pain, to calm nervousness, or to aid sleep. Some, like alcohol and nicotine, are available in various forms for purchase without prescription. Others, including cannabis and cocaine, are prohibited under criminal law and can only be obtained illegally.

Although substance abuse can affect any Canadian regardless of sex, age, ethnic origin, educational level, or employment status, it seems that certain groups are more at risk. At all ages, men are more likely than women to use illegal drugs, while women are more likely to use prescription drugs that could lead to dependency. Young adults are more likely than older people to use illegal drugs but older people are more likely to have multiple drug prescriptions. Groups in which abuse of drugs is prevalent include street youths and some aboriginal people. In federal prisons, almost seven out of ten offenders have alcohol or other drug problems severe enough to warrant formal intervention. In all these groups, the negative physical and social effects can be profound for them, their families and their communities.

Debate also continues on the beneficial versus the harmful effects of certain substances. For example, with respect to alcohol, various forms of heart disease appear to be less common among light to moderate drinkers than among abstainers and heavy drinkers suggesting that alcohol, if used in moderation, may actually produce health benefits but over the long term could be problematic for certain individuals. With respect to cannabis, outside of its adverse effects on the neurological, respiratory and immunological systems, there are also indications of its therapeutic value and limited toxicity in the relief of various health conditions. This conflicting information presents a dilemma for governments seeking to develop sound public health policy.

C. Why Do People Become Dependent on Drugs?

Another difficulty in developing sound public policy in this area is the lack of consensus on the nature of drug dependence: why do some individuals exhibit a compulsive pattern of drug use leading to addiction while others can use the same drugs occasionally without developing such dependence? Because of difficulty with data collection, most of our knowledge about the effects of drugs is based on observations of cases where dependency has led to overdoses or to criminal activity. There is much less information about individuals who use drugs without dependency.

Discussions of drug use may adopt a medical, psychological, sociological, economic, legal, criminological, pharmacological or philosophical approach. Drug dependence may be attributed to a genetic component (for example, an inherited susceptibility for alcoholism); an addictive personality type (that easily becomes dependent on everything from coffee to cocaine); critical environmental circumstances (that can determine an individual’s behaviours and health); and, more recently, a physiological connection (whereby certain brain cells create a craving for particular substances).

Certain groups, including males, the unemployed, aboriginal peoples, and street youth, have been identified as having a higher chance of becoming dependent on drugs. Greater understanding of the predisposing factors can assist in preventing and treating the dependency.

However, it is significant that the vast majority of people who report having used illegal drugs do not continue using them throughout their lives. According to the publication Canadian Profile: Alcohol, Tobacco and Other Drugs, in 1994, 23.1% reported having used cannabis but only 7.4% were current users. Cocaine or crack had been used by 3.8% but only 0.7% were current users. Similarly, 5.9% reported having used LSD, speed and/or heroin, but only 1.1% were still doing so.

D. What are the Substances and the Consequences of Abuse?

The following section describes various legal and illegal substances using data drawn primarily from the 1994, 1995, 1997 and 1999 versions of Canadian Profile: Alcohol, Tobacco and Other Drugs.

1. Legal Substances

a. Alcohol

The decline in alcohol sales observed through the 1980s and 1990s changed to a slight rise in 1996-1997. The percentage of Canadians over 15 years of age reporting themselves to be current drinkers rose from 72% in 1994 to 77% in 1997. Drinkers were more likely to be young men in their early twenties with a post-secondary education and higher- than-average income. Alcohol consumption by youth under the legal drinking age is not easy to assess but estimates suggest that three in four students (75%) under drinking age have used alcohol.

Canadian Profile reported that, in 1995-1996, there were 80,946 alcohol-related hospital separations, constituting 3.9% of all hospitalizations for men and 1.6% for women. The greatest number of alcohol-related hospital separations were for accidental falls, alcohol dependence syndrome, and motor vehicle accidents. Of the 6,503 Canadians who lost their lives because of alcohol consumption, the largest number of alcohol-related deaths stemmed from motor vehicle accidents, alcoholic liver cirrhosis, and alcohol-related suicides. There are no standardized national data on the rate of occurrence of fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE).

The control and sale of alcohol is regulated by each province, while drinking and driving offences fall under federal legislation. Although the number of federal drinking and driving offences has generally been declining, these violations continue to be one of the most common crimes committed by Canadian males. The 1996-1997 National Population Health Survey found that one in 13 respondents acknowledged driving after consuming two or more drinks in the previous hour. The rates were highest among males aged 20 to 24 years.

b. Tobacco

Mounting scientific evidence that cigarettes and other tobacco products are addictive point to nicotine as the causative drug. Results from Health Canada’s study to measure nicotine levels in cigarettes between 1968 and 1995 indicated that the level of nicotine in tobacco used in cigarettes had increased by 53% over this time.

In 1965, almost 50% of Canadians stated that they smoked. By 1994, 27% of respondents to the Canadian Alcohol and other Drug Survey indicated that they did so; 26% of respondents said that they were former smokers and 46% were non-smokers. At the same time as the proportion of smokers was decreasing, so was the level of consumption of those who continued to smoke. Men were more likely to be current and former smokers than were women. Individuals with low income, lower levels of education and low literacy skills had much higher rates of smoking.

In the 1999 Canadian Tobacco Use Monitoring Survey, 25% of people aged 15 years or older reported that they smoked. The 20-24 age group had the highest prevalence of smoking, at 35% overall. Smoking prevalence is highest among Quebec teens aged 15 to 19 years at 36%.

The 1999 Canadian Profile offered estimates of tobacco-attributable morbidity and mortality. The estimated 34,728 deaths due to tobacco represented 16.5% of total mortality in Canada for 1995. Lung cancer deaths represent 35% of tobacco-related deaths. More than two-thirds of those who die from tobacco-related deaths are men.

Although the prohibitions and enforcement efforts have increased at the federal, provincial and municipal levels, statistics on the offences and penalties are not readily available.

c. Solvents

Collection of data on solvents use in Canada is limited. Data from the Canadian Alcohol and Drug Survey indicated that solvents were used by less than 0.1% of adults. In 1990 and 1992 surveys of Toronto and Halifax street youth, between 8% to 15% of respondents reported the use of solvents in the past year. This contrasts with the findings for the general Ontario student population, where the Ontario Addiction Research Foundation found a slight increase of sniffing of glue and other solvents, from 1.6% of those surveyed in 1991 to 2.3% in 1993.

Recent media stories have pointed out that solvent abuse is a major problem among young aboriginal people. The 1993 First Nations and Inuit Community Youth Solvent Abuse Survey indicated that solvent users were most often males between 12 and 19 years of age. The majority of young people use solvents to experiment (42.3%) or for social reasons (37.5%).

The characteristics of solvent users include: poor socio-economic background, low educational level, and troubled family circumstances. The health problems associated with solvent abuse are not well documented but include respiratory difficulties, liver and kidney disturbances, blood abnormalities and nervous system damage.

d. Prescription Drugs

The 1996-1997 National Population Health Survey collected data on self-reported use of sleeping pills, tranquilizers, diet pills and stimulants, anti-depressants, and narcotic pain relievers. Overall, 11.6% of Canadians aged 15 years and older used at least one of the five categories. The proportion reporting use increased consistently with age; in comparison to men, women of all age groups tended to use all categories of prescription drugs at a higher rate. Regionally, sleeping pill and anti-depressant use was highest in British Columbia, tranquilizer use was highest in Quebec, and narcotic pain reliever use was highest in Alberta.

In hospitals, the coding system used for data collection does not distinguish between drug-related problems caused by misuse of legal prescription drugs and those caused by use of illegal drugs. In 1990-1991, 33.5% of all drug-related separations from general and psychiatric hospitals were for mental disorders such as drug dependence syndrome and psychoses; the remaining were for poisonings involving prescription drugs. Overall, male patients were more likely to have drug-related mental disorders while female patients were more likely to have poisoning-related conditions.

Thefts involving drugs controlled under the Narcotic Control Act and the Food and Drugs Act decreased slightly from 1995 to 1997. Pharmacies continued to be the most frequent target, accounting for more than half of thefts, followed by hospitals and licensed dealers.

2. Illegal Substances

Data on the national use of drugs such as cannabis, LSD, cocaine and heroin was last collected in the 1994 Canada’s Alcohol and other Drugs Survey. These substances are currently regulated by the Controlled Drugs and Substances Act (CDSA). This legislation combining Parts III and IV of the Food and Drugs Act and the Narcotic Control Act came into force in May 1997. Use of the substances is either totally prohibited or strictly controlled under the CDSA.

a. Cannabis

When smoked or ingested, cannabis produces a short-term euphoric effect. High doses can cause perceptual distortion, disorganized thoughts and mild hallucinations. The addictiveness of cannabis and its rate of serious adverse reactions is addictive and the rate of serious adverse reactions to cannabis in the general population has not been fully determined. However, smoking of cannabis is associated with an increase in respiratory tract conditions.

In 1994, 23% of the population over the age of 15 years reported use of cannabis more than once. Although in 1993 only 4.2% reported current use, in 1994 reported use increased to 7.4%. In 1994, the highest reported use during the past year was 25.4% among 15- to 17-year-olds, 23.0% among 18- to 19-years-olds, and 19.3% among the 20- to 24-year-olds. While 11.6% of the British Columbia population reported current use in 1994, the percentage of users in Newfoundland was 3.8.

In 1996, when the Narcotic Control Act and the Food and Drugs Act were still the principal statutes covering illicit drugs, cannabis offences accounted for 72% of all drug offences. Generally, about two-thirds of the convictions for cannabis were related to possession.

b. Cocaine

Cocaine – a powerful, short-acting, central nervous system stimulant – can be inhaled, smoked or injected. Clinical studies of heavy cocaine users indicated that few experienced the severe withdrawal symptoms associated with physical addiction. Repeated use did, however, lead to strong psychological craving and consequent dependence.

In 1994, less than 1% of the population reported being current cocaine or crack users. Lifetime users tended to be males in the 25 to 34 age group. Regionally, cocaine use was greatest in British Columbia at 8.1%.

In 1996, cocaine offences accounted for 17% of all drug offences.

c. Heroin

Heroin is a narcotic analgesic derived from morphine. The preferred mode of administration is injection. Tolerance develops rapidly with regular use. The risk of death from overdose is great, due to the varying quality of the drug. There is also a risk of transmittal of AIDS or hepatitis through shared needles.

After a steady increase from 1988 to 1991, offences involving heroin declined in 1992, representing 2.2% of total drug offences. By 1994, heroin offences were at 2.0% of total drug offences.

Regulations produced in 1985 permit heroin importation for medical use, particularly for pain control.

E. The Costs of Substance Abuse

Costs associated with substance abuse occur in several areas:

health – In addition to the long-term health problems associated with substance abuse, immediate crises can arise if the amount of drug consumed is misjudged, the drug is contaminated or too strong, or several substances are taken in combination.
social – Substance abuse can lead to family breakdown when members are unable to maintain close relationships or to alter their personal lifestyle to accommodate others. Young people in aboriginal communities, the poorest of Canada’s poor, can feel a hopelessness and despair that leads them to withdraw from their community, to abuse substances and sometimes to commit suicide.
workplace – Tardiness, constant absences and inability to work may result from intoxication or drug-induced apathy. Reduced productivity may lead to unemployment with all its associated social and health costs. Those addicted to substances have a higher rate of unemployment than average and the unemployed report more use of drugs, including alcohol, than the general population.
enforcement – More policing is required to ensure adherence to laws controlling the manufacture and distribution of certain drugs and because some substances produce extremely violent or verbally abusive behaviour. For example, the Alberta Alcohol and Drug Abuse Commission reported that alcohol was involved in about 80% of the provinces’ cases of spousal violence. It has also been reported that more than half of the individuals given penitentiary sentences since 1990 were using drugs or alcohol on the day they committed their crime.

In its 1996 assessment of the costs associated with substance abuse, the Canadian Centre on Substance Abuse (CCSA) concluded that, in 1992 in Canada, substance abuse cost more than $18.45 billion. This amounted to $649 for every Canadian and was equivalent to 2.7% of the Gross Domestic Product. Productivity losses from illness and premature death accounted for $11.78 billion, or 64% of all costs. The cost to the health care system was more than $4 billion and to law enforcement another $1.76 billion. The Centre estimated that 40,930 deaths were attributable to substance abuse in 1992, representing 21% of the total mortality for that year.

The CCSA estimate, which used a cost-of-illness approach, is considered to be both more conservative and more accurate than previous estimates. The direct expenses included health care costs such as those for hospital and agency treatment, professional fees, ambulance services and prescription drugs; losses associated with workplace Employee Assistance Programs and drug testing; administrative costs for transfer payments such as social welfare, workers’ compensation, and other insurance; costs for prevention and research; costs of law enforcement such as those for police, courts, corrections and customs and excise; as well as other direct costs such as those for fire damage, traffic accidents, and reduced property values in drug-ridden neighbourhoods. Indirect costs included productivity losses due to absenteeism, mortality, and crime.

When individual substances are considered, tobacco accounts for more than half of the total costs at $9.56 billion, alcohol for 40% of costs at $7.52 billion, and illicit drugs for 7% at $1.37 billion. In each case, the largest economic cost is for lost productivity due to illness and premature death. This study did not calculate the cost of misuse of prescription drugs.

F. What Measures Are Currently Used to Address Substance Abuse?

Three potential approaches to control the use of drugs include: prohibition, legalization and medicalization. These models differ greatly in how they define drug use, the user, the consequences of drug use and appropriate societal reactions. Supporters of prohibition assume that the use of drugs is morally corrupt behaviour and that control is best achieved by legal sanctions. Proponents of legalization argue that problems are caused by the criminalization of drug use and users and that criminal penalties for use should be removed. Under the medicalization approach, the user is perceived to be sick and thus in need of medical attention and control.

A proposed alternative, “harm reduction,” grew out of efforts in the 1980s to reduce the risks for drug users. It adopts a value-neutral view of drug use and users, one that does not see these as intrinsically immoral, criminal or medically deviant.

Harm reduction, although subject to varied definitions, features in current initiatives aimed at prevention, treatment and control. Strategies aim to reduce the adverse effects of substances by discouraging their initial use and encouraging users to consume more moderately or to stop using the substances. Strategies attempt to persuade people who use potentially harmful substances to incur reduced or minimal adverse effects through use of drug substitutes, such as nicotine patches for cigarettes or methadone for heroin, or through medically managed and supervised use of heroin. Strategies can also be based on legalization, where the manufacture, sale or possession of substances is authorized, with perhaps some regulations relating to their sale, advertising, or place of consumption. Other strategies incorporate decriminalization, either implicit, where certain actions such as needle exchange programs are allowed, or explicit, where criminal penalties for the consumption and possession of an illicit substance are reduced or eliminated.

Current action takes place in three areas:

1. Education and Prevention

Federal government interventions through education and prevention programs currently aim to help people avoid the use of harmful substances and to enhance their ability to control their use. Education, motivation, and awareness-building are combined with regulation and taxation to achieve the goals, recognizing that different groups have different needs in relation to prevention of substance abuse.

The Canadian Centre on Substance Abuse, an important partner in Canada’s Drug Strategy, was created in 1988 to increase public awareness through data gathering, information distribution and policy formulation. In the tobacco area, the National Clearinghouse on Tobacco and Health provides a comprehensive educational, social, fiscal and legislative approach to tobacco control information.

As a group, youth and young adults have the highest rates of alcohol, tobacco and marijuana use and require particular encouragement to avoid the associated health risks. The federal government has a role in measures to encourage healthy choices; these measures include: increasing the price of alcohol and cigarettes; creating more smoke-free and alcohol-free environments; limiting advertising of tobacco and alcohol products; and supporting education programs in schools and media.

Researchers have drawn attention to the fact that, while seniors make up only 11% of Canada’s population, they use 25% of all prescription drugs; 19% of hospital admissions for people over 50 years of age are related to the improper use and side effects of prescription drugs. Older people may deliberately misuse drugs as a result of stress, anxiety, loneliness or a perceived inability to cope. But misuse can also result from over-prescribing by physicians, lack of monitoring by pharmacists, limited supervision by caregivers, poor communication between health professionals and patients, inadequate literacy levels (among seniors), and inadequate follow-up. Educating physicians to take greater care in prescribing and involving pharmacists to identify unnecessary drugs or drugs that react badly with other medication is seen as a good preventive measure.

Needle exchange programs provide health professionals with the opportunity to offer treatments but are aimed primarily at harm reduction. By offering clean needles to addicts it is hoped to discourage their common practice of sharing dirty needles when injecting drugs. In 1994, of the 7.7% of Canadians who reported injecting drugs, 41% had shared needles at some time. Some of the existing outreach programs involving needle exchange date from 1989, when the spread of AIDS among intravenous drug users became a major concern. Situated in mobile as well as stationary units, these programs deliver community-based and cost-effective prevention but have been threatened by governmental cost-cutting measures.

2. Treatment and Rehabilitation

Although the provinces and local communities have the primary responsibility for the development and implementation of drug and alcohol treatment and rehabilitation programs, the federal government has a role in funding them. These programs, which usually address addiction to alcohol and drugs together, include detoxification, early identification and intervention and assessment and referral, basic counselling, therapeutic interventions, clinical follow-up and some workplace initiatives.

Under the Drug Strategy, federal funding was committed to provinces and territories to increase the availability of alcohol and drug treatment and rehabilitation programs. In 1988, the federal government established cost-sharing agreements to provide $70 million over five years; these agreements were established under the authority of the National Health and Welfare Act. In 1998, responsibility for administering the Alcohol and Drug Treatment and Rehabilitation Program was returned to Health Canada from Human Resources Development Canada. The aim is that, through agreements with the provinces, the department will support related programs, collaborate on national guidelines and best practices, and facilitate information synthesis and dissemination.

Treatment centres with specific programs for particular groups are a relatively new phenomenon. Women, Aboriginal peoples and youth are among the groups to be targeted. People who work in the field suggest that women are more likely to hide their substance abuse problems for fear of stigmatization or lest they might have to give up their children. Status of Women Canada examined the issue of substance use during pregnancy and recommended greater federal allocation of resources.

All young substance abusers need residential treatment centres and outpatient programs that are open at all times of the day and in many settings. The lack of facilities for young solvent abusers in northern Canada is particularly problematic. The situation was only partially alleviated in 1995 when the federal Health Minister announced funding for six permanent national solvent abuse treatment centres for First Nations and Inuit.

Methadone maintenance programs are aimed at helping heroin addicts when other forms of treatment have failed. Under strict medical supervision, addicts – who must participate in mandatory counselling – are administered methadone, a chemical substitute for heroin. In 2000, Canadian researchers, as part of the North American Opiate Maintenance Initiative, began the process of obtaining federal approval for clinical trials involving the use of heroin as treatment for addicts.

3. Enforcement and Control

At the federal level, various government bodies are involved in control, detection and enforcement efforts that incur high costs for personnel and equipment. Efforts to control tobacco and alcohol include advertising restrictions, taxation, and limits on sales. At the federal level, the 1997 Tobacco Act provides for a broad range of restrictions on the composition of tobacco products, young persons’ access to tobacco products, tobacco product labelling, and tobacco product advertisement endorsement and sponsorship. For alcohol, the Broadcasting Act and the Code for the Broadcast Advertising of Alcoholic Beverages regulate advertising. The Ministry of the Solicitor General is the lead department with respect to policing, including the Royal Canadian Mounted Police. The Ministry of National Revenue is responsible for the Customs and Excise Program charged with controlling the movement of certain goods, including tobacco, alcohol and drugs.

The failure of past law enforcement efforts to counteract the trade in illegal drugs has led to arguments for decriminalization or the lifting of criminal prohibitions on personal possession of currently prohibited substances. In support of decriminalization it is claimed that current enforcement costs deplete available resources for health-related programs, that violence is produced by the illegal drug trade, and that the treatment for abuse of harmful legal drugs and treatment for use of illegal drugs are inconsistent. Arguments against decriminalization cite the probability that health and social costs would increase if the stigma of drug use were to be removed.

One of the legal concerns with respect to substance abuse is the continued disparity between court sentences. For example, judges can give anything from an absolute discharge to up to seven years’ imprisonment for simple possession of cannabis. The fear is that the current system continues the criminal penalties and social disadvantages resulting from encounters with the legal system yet without evidence that it is a major deterrent to illegal trade or drug use. It has been argued that court diversion programs are needed to treat drug users with major psychological or addiction or abuse problems.

Other efforts at control have focused on substance use in the workplace. Employers’ concerns have led to various forms of drug testing programs in both the public and private sectors. At the federal level, testing of members of the Canadian Forces began in 1992; in the private sector, companies such as Imperial Oil Limited test new employees and employees in safety-sensitive positions. Both the federal Privacy Commissioner and Human Rights Commissioner have argued that such testing presents problems.

PARLIAMENTARY ACTION

1987 – House of Commons Standing Committee on National Health and Welfare inquired into alcohol and other drug abuse in Canada. The report was entitled Booze, Pills and Dope: Reducing Substance Abuse in Canada.

1987 - 1988 – The House of Commons and the Senate studied and passed Bill C-51, Tobacco Products Control Act banning tobacco advertising and Bill C-204, Non-Smokers’ Health Act restricting smoking in federally regulated workplaces.

1990 – House of Commons Standing Committee on Transportation reviewed the government’s strategy on prohibiting and preventing substance use by those in safety-sensitive positions in the federal transportation sector.

1992 – House of Commons Subcommittee on Health Issues (Standing Committee on Health and Welfare, Social Affairs, Seniors and the Status of Women) issued a report entitled Foetal Alcohol Syndrome: A Preventable Tragedy.

1994 – House of Commons Standing Committee on Health and the Standing Senate Committee on Legal and Constitutional Affairs studied Controlled Drugs and Substances Act (Bill C-7). Like Bill C-85, introduced in the previous Parliament, Bill C-7 sought to amalgamate the 1961 Narcotic Control Act and the Food and Drugs Act and to bring Canada into conformity with its international obligations under several U.N. Conventions.

1994 – House of Commons Standing Committee on Health in its report Toward Zero Consumption: Generic Packaging of Tobacco Products, affirmed that plain packaging could be a reasonable step in the overall strategy to reduce tobacco consumption.

1996 – House of Commons Subcommittee of Standing Committee on Health considers Bill C-222 (a Private Member’s bill) to amend the Food and Drugs Act to require warnings on alcoholic beverage containers. A Senate (Private Member’s) Bill, S-5, also focuses on tobacco.

1996 – Pursuant to a recommendation from the Subcommittee that had studied Bill C-7 on controlled drugs, House of Commons Standing Committee on Health reviewed Canada’s drug policy. The Committee heard from witnesses about the prevalence, effects and associated costs of alcohol, tobacco, prescription drugs, cannabis, cocaine, and opiates, but did not prepare a report prior to the 1997 election.

1996 - 1997 – House of Commons Standing Committee on Health and the Senate Committee on Legal and Constitutional Affairs considered Bill C-71, an Act to regulate the manufacture, sale, labelling and promotion of tobacco products. The bill with amendments received Royal Assent in April 1997.

1999 – House of Commons Standing Committee on Justice and Human Rights studied the impaired driving provisions of the Criminal Code and issued a report entitled Toward Eliminating Impaired Driving.

2000 – Standing Senate Committee on Energy, Environment and Natural Resources considered Bill S-20, Tobacco Youth Protection Act.

2000 – Senate Special Committee on Illegal Drugs began public hearings.

SELECTIVE CHRONOLOGY

1906 – Adulteration Act prohibited changes to food, drug and drink products sold for human consumption including alcohol, opium, Indian hemp and tobacco.

1908 – The federal Opium Act was passed, prohibiting the import, manufacture and sale of opiates for non-medical purposes.

1908 – The federal Tobacco Restraint Act prohibiting the sale of tobacco to persons under 16 years of age was adopted.

1911 – Opium and Drug Act provided an expanded list of controlled drugs including cocaine and morphine.

1914 – House of Commons Select Committee on Cigarette Evils considered banning cigarettes.

1920 – Food and Drugs Act replaced the Adulteration Act.

1923 – Cannabis Indica (Indian Hemp) was added to the list of controlled drugs under the Opium and Narcotic Drug Act.

1960 – The Food and Drugs Act was broadened to include a focus on the controlled use of amphetamines, barbiturates, and other drugs.

1961 – The Narcotic Control Act was passed and Canada ratified the U.N. Single Convention on Narcotic Drugs.

1971 – The Non-Medical Use of Drugs Directorate was formed at the Department of National Health and Welfare; this was the first time a single federal agency had assumed responsibility for coordinating research and programs in alcohol and drug dependency.

1973 – The report of the Le Dain Commission (the Commission of Inquiry into the Non-Medical Use of Drugs established in 1970) supported the gradual withdrawal of criminal sanctions against the user along with the parallel development of alternative means to discourage use and reduce harm.

1975 – The Native Alcohol Abuse Program was established to provide support to programs for Treaty Indians; expanded in 1982 to include drugs.

1987 – The National Drug Strategy, a new federal program to fight drug abuse through prevention and enforcement, was announced.

1988 – Canadian Centre on Substance Abuse established to provide a national focus on alcohol and drug abuse.

1990 – The Minister of Transport proposed a policy on substance use in the workplace that would focus on education of employees, with testing to be limited to specific circumstances, not done at random. The policy would affect four federally regulated transportation sectors: marine, aviation, rail and trucking.

1992 – Canada’s Drug Strategy was combined with the Driving While Impaired Strategy and renewed for another five years. Heavier emphasis was placed on prevention of substance abuse and on reduction of harm to users.

1994 – The Tobacco Demand Reduction Strategy, a three-year initiative, was announced.

1994 – Minister of Health initiated a solvent abuse prevention and treatment program.

1995 – The Supreme Court of Canada on RJR-MacDonald Inc. v. Attorney General of Canada struck down five sections of the Tobacco Products Control Act. Health Canada responded with its Blueprint document for comprehensive tobacco control.

1997 – Canada’s Drug Strategy and the Tobacco Demand Reduction Strategy were concluded.

1997 – The Tobacco Act was passed to regulate the composition of tobacco products, young persons’ access, labelling, advertisement, endorsement and sponsorship.

1997 – The Controlled Drugs and Substances Act came into force.

1998 – Federal government reaffirmed its commitment to the principles of Canada’s Drug Strategy but without designated funding; Tobacco Control Initiative announced.

1999 – Federal/Provincial/Territorial Working Group on Injection Drug Use established.

2000 – National FAS (fetal alcohol syndrome)/FAE (fetal alcohol effect) Initiative announced with funding over three years.

SELECTED REFERENCES

Bergob, Michael. “Drug Use Among Senior Canadians.” Canadian Social Trends, 33, Summer 1994, p. 25-29.

Blackwell, Judith and Patricia Erickson. Illegal Drugs in Canada, A Risky Business. Nelson Canada, Scarborough, Ontario, 1988.

Canadian Centre on Substance Abuse and Addiction Research Foundation. Canadian Profile: Alcohol, Tobacco and Other Drugs, Ottawa, 1994, 1995, 1997, 1999.

Cunningham, Rob. Smoke and Mirrors, the Canadian Tobacco War. International Development Research Centre, Ottawa, 1996.

Eno, John et al. “Offender Substance Abuse Treatment: The Pre-Release Program.” Paper presented at the Annual Convention of the Canadian Psychological Association, Montreal, 1993.

Erickson, Patricia, Diane Riley, Yuet Cheung and Patrick O’Hare (eds.). Harm Reduction: A New Direction for Drug Policies and Programs. University of Toronto Press, Toronto, 1997.

Giffen, P.J., Shirley Endicott and Sylvia Lambert. Panic and Indifference, The Politics of Canada’s Drug Laws. Canadian Centre on Substance Abuse, Ottawa, 1991.

Health Canada. Canada’s Drug Strategy, Supply and Services Canada, Ottawa, 1998.

Health Canada. Tobacco Control: A Blueprint to Protect the Health of Canadians. Supply and Services, Ottawa, 1995.

Roberts, Gary and Alan Ogborne. Profile: Substance Abuse Treatment and Rehabilitation in Canada, Health Canada, Ottawa, 1999.

Rutman, Deborah et al. Substance Use and Pregnancy: Conceiving Women in the Policy-Making Process, Status of Women Canada, Ottawa, 2000.

Single, Eric et al. “The Costs of Substance Abuse in Canada, Highlights.” Canadian Centre on Substance Abuse, Ottawa, 1996.

Smart, Reginald and Alan Ogborne. Northern Spirits: A Social History of Alcohol in Canada, Addiction Research Foundation, Toronto, 1996.

Statistics Canada. Canadian Tobacco Use Monitoring Survey, Ottawa, 1999.

Tamblyn, Robyn et al. “Questionable Prescribing for Elderly Patients in Quebec.” Canadian Medical Association Journal, 150(11), 1994, p. 1801-1809.

* The original version of this Current Issue Review was published in December 1994; the paper has regularly been updated since that time.